Appeals Converted to Reopenings

Noridian receives a large number of appeal requests for corrections that should be completed through the Noridian Medicare Portal (NMP) Self-Service Reopenings function. These appeals will be processed as reopenings. Providers looking for information through the NMP on an appeal that has been converted to a reopening will find the claim information on their Remittance Advice (RA).

Providers will still have appeal rights on claims that have been processed as reopenings. The appeals timeframe of 120 days from the initial determination will remain regardless.

The Reopening process allows providers to correct clerical errors or omissions without having to request a formal appeal. Most reopenings can be initiated through Self-Service Reopenings via the NMP. Services considered too complex that cannot be completed through the NMP Self-Service Reopening function should be submitted as either a written reopening or redetermination in the NMP.

The CMS Internet Only Manual (IOM), Publication 100-09, Chapter 6, Section 50 mandates that all providers first access inquiries through self-service technology. This process change will allow Noridian to meet CMS requirements.

 

            Last Updated Wed, 30 Sep 2020 17:55:59 +0000